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City Of Decatur ��� Gallagher <br /> ,r•CORE 3�C�. <br /> Binding Requirements: <br /> . • <br /> Subject To: <br /> -Prior to Binding: Receipt and UW Review of all Underlying Quotes I <br /> -A Signed Umbrella/Excess Acord 131 Application or Acord 63 Acknowledging Fraud Statement Wthin 30 Days of BindingE <br /> -Signed Application, Including Supplemental Application if Submitted,Within 30 Days of Binding <br /> ; -A Signed/Dated Copy of Terrorism Disclosure MKL TERR-4(01/08)is Required to Bind <br /> ' -We Require 5 Years of Currently Valued Insurance Company Loss Runs Confirming the Loss Information Previously <br /> ', Submitted Within 30 Days of Binding <br /> -. _ _. _ ............ .... ......... _ _ .. _ � <br /> Other Significant Terms and Conditions/Restrictions: <br /> � s <br /> Optional TRIA Premium Includes Additional Taxes of$45 <br /> _ _ _ <br /> Premium $25,000.00 <br /> Taxes <br /> Surplus Lines Tax $875.00 <br /> Stamping Office Fee $19.00 <br /> Total Taxes $894.00 <br /> ESTIMATED PROGRAM COST $27,189.00 <br /> Minimum Earned Premium- 25.00% <br /> TRIA/TRIPRA PREMIUM $1,295.00 Included Above <br /> (+Additional Surcharges, Taxes and Fees as applicable) <br /> Subject to Audit: Not Auditable <br /> ,�f�'����:;�` <br /> �:��,3s: <br /> .4`ri�R'�3� �y�r <br /> �.`R <br /> . .:,:,zri;;, �.a�,.::,,. <br /> ,..;:i��';�:,. <br /> ��Fz�-:;.'".?t t:; <br /> � rv-v`���y"�: <br /> 33 `:�"'`�:f� <br /> ri=��=A`:. <br /> ��� <br /> �; � a r��� >�,:: <br /> _.,: <br /> .:,,. <br /> .F_.�,�.:..�:�_ , . <br />